Evidence map›Paper›PMID 39586307›Full record

ArticleThe Lancet. Respiratory medicine2025

Development of an asthma health-care burden score as a measure of severity and predictor of remission in SARP III and U-BIOPRED: results from two major longitudinal asthma cohorts.

Joe G Zein, Nazanin Zounemat-Kerman, Ian M Adcock, Bo Hu, Amy Attaway, Mario Castro, Sven-Erik Dahlén, Loren C Denlinger, Serpil C Erzurum, John V Fahy and 17 more

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Article in The Lancet. Respiratory medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

27 authors.

Joe G ZeinDivision of Pulmonary Medicine, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA. Electronic address: Zein.Joe@mayo.edu.
Nazanin Zounemat-KermanData Science Institute and National Heart & Lung Institute, Imperial College London, London, UK.
Ian M AdcockData Science Institute and National Heart & Lung Institute, Imperial College London, London, UK.
Bo HuLerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Amy AttawayLerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Mario CastroDivision of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
Sven-Erik DahlénThe National Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.
Loren C DenlingerDepartment of Medicine, University of Wisconsin School of Medicine, Madison, WI, USA.
Serpil C ErzurumLerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
John V FahyDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
Benjamin GastonDepartment of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Annette T HastieDepartment of Medicine, Wake Forest University, Winston-Salem, NC, USA.
Elliot IsraelDivision of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Nizar N JarjourDepartment of Medicine, University of Wisconsin School of Medicine, Madison, WI, USA.
Bruce D LevyDivision of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
David T MaugerCenter for Biostatistics and Epidemiology, Pennsylvania State University School of Medicine, Hershey, PA, USA.
Wendy MooreDepartment of Medicine, Wake Forest University, Winston-Salem, NC, USA.
Michael C PetersDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
Kaharu SuminoDivision of Pulmonary and Critical Care Medicine, Washington University College of Medicine, Saint Louis, MO, USA.
Elizabeth TownsendDepartment of Medicine, University of Wisconsin School of Medicine, Madison, WI, USA.
Prescott WoodruffDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
Victor E OrtegaDivision of Pulmonary Medicine, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Sally E WenzelDepartment of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA.
Deborah A MeyersDivision of Pulmonary Medicine, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Kian Fan ChungData Science Institute and National Heart & Lung Institute, Imperial College London, London, UK.
Eugene R BleeckerDivision of Pulmonary Medicine, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) Consortium and the the US National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP III)

Funding

S-nitrosylation signaling in asthmaP01HL158507 · NHLBI · INDIANA UNIVERSITY INDIANAPOLIS · PI LAHM, TIM · 2021 to 2025
$12.0M
Leveraging Pharmacogenomics in Asthma for Predication, Mechanism and EndotypingR01HL161362 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI EUGENE ROLAND BLEECKER, GEOFFREY L CHUPP · 2022 to 2026
$8.4M
Clinical Coordinating Center for the Severe Asthma Research Program (SARP)U10HL109086 · NHLBI · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · PI MAUGER, DAVID T. · 2011 to 2017
$8.1M
AMSA: ALXR/FBR Mediated Signaling in Severe AsthmaU10HL109172 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI ISRAEL, ELLIOT, LEVY, BRUCE D · 2011 to 2016
$4.2M
Airway redox biochemistry as a deteriminant of asthma phenotype during adolescen*U10HL109250 · NHLBI · UNIVERSITY OF VIRGINIA · PI ERZURUM, SERPIL C., GASTON, BENJAMIN · 2011 to 2016
$4.2M
Clinical and Molecular Phenotypes of Severe AsthmaU10HL109146 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI FAHY, JOHN V · 2011 to 2016
$4.0M
Implications and Stability of Clinical and Molecular Phenotypes of Severe AsthmaU10HL109152 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI WENZEL, SALLY E · 2011 to 2016
$3.9M
Stability of Severe Asthma Phenotypes: Impact of ExacerbationsU10HL109168 · NHLBI · UNIVERSITY OF WISCONSIN-MADISON · PI JARJOUR, NIZAR N · 2011 to 2016
$3.9M
Severe Asthma Research Program (SARP)-Washington UniversityU10HL109257 · NHLBI · WASHINGTON UNIVERSITY · PI CASTRO, MARIO · 2011 to 2016
$3.8M
Longitudinal Phenomics and Genetics of Severe AsthmaU10HL109164 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI BLEECKER, EUGENE ROLAND, MEYERS, DEBORAH A. · 2011 to 2016
$3.8M
The Impact of Biological Sex on Asthma OutcomesR01HL161674 · NHLBI · MAYO CLINIC ARIZONA · PI Joe Zein · 2023 to 2026
$1.5M
NHLBI NIH HHS P01 HL158507NHLBI NIH HHS R01 HL161362NHLBI NIH HHS R01 HL161674NHLBI NIH HHS U10 HL109086NHLBI NIH HHS U10 HL109146NHLBI NIH HHS U10 HL109152NHLBI NIH HHS U10 HL109164NHLBI NIH HHS U10 HL109168NHLBI NIH HHS U10 HL109172NHLBI NIH HHS U10 HL109250NHLBI NIH HHS U10 HL109257
6 · The paper itself

Abstract

backgroundCurrent asthma guidelines, including those of the European Respiratory Society (ERS) and American Thoracic Society (ATS), suboptimally predict asthma remission, disease severity, and health-care utilisation. We aimed to establish a novel approach to assess asthma severity based on asthma health-care burden data.

methodsWe analysed prospectively collected data from the Severe Asthma Research Program III (SARP III; USA) and the European Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED; 11 European countries) to calculate a composite burden score based on asthma exacerbations and health-care utilisation, which was modified to include the use of short-acting beta agonists (SABAs) to reflect asthma symptom burden.

findingsIn SARP III, 528 adult participants with asthma were followed up for a mean of 4·4 (SD 1·6) years, and 312 (59%) had severe asthma according to the ERS-ATS definition. Among the 205 participants with asthma who used rescue SABAs daily, 90 used these two or more times a day. In U-BIOPRED, 509 adult participants with asthma were followed up for 1 year, and 421 (83%) had severe asthma. The burden score was less than 1·29 per patient-year in 106 (34%) of 312 SARP III participants and in 80 (19%) of 421 U-BIOPRED participants with severe asthma. By contrast, the burden score was above the median value in 58 (28%) SARP III and 24 (27%) U-BIOPRED participants with non-severe asthma. In both cohorts, the burden score negatively correlated with lung function, asthma control, and quality of life. A burden score of 0·15 or lower predicted asthma remission with a sensitivity greater than 91% and a specificity of 99%.

interpretationOur findings highlight considerable discrepancies between the current definition of asthma severity and our burden score. Although the definition of severe asthma proposed by the ERS-ATS and the and Global Initiative for Asthma (GINA) is based on prescribed asthma medications, our personalised health-care burden score includes patient-centred data that reflect disease severity and accurately predicts asthma remission. Subject to prospective validation, the burden score could help to optimise the management of high-risk individuals with asthma.

fundingSARP III: US National Heart, Lung, and Blood Institute; AstraZeneca; Boehringer Ingelheim; Genentech; GlaxoSmithKline; Sanofi Genzyme/Regeneron; and Teva Pharmaceuticals. U-BIOPRED: Innovative Medicines Initiative Joint Undertaking (EU's Seventh Framework Programme and European Federation of Pharmaceutical Industries and Associations) and eTRIKS project.

Indexed as

AsthmaSeverity of Illness IndexAdultAnti-Asthmatic AgentsCost of IllnessEuropeFemaleHumansLongitudinal StudiesMaleMiddle AgedProspective StudiesRemission InductionUnited StatesAnti-Asthmatic Agents

Identifiers

PMID39586307
PMCPMC11700758

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